Individual
JAN MICHAEL BROAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
6 SANDPIPER PL, SUPERIOR, WI 54880-5390
(715) 392-9192
Mailing address
6 SANDPIPER PL, SUPERIOR, WI 54880-5390
(715) 392-9192
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R134618-7
MN
Other
Enumeration date
11/18/2010
Last updated
11/18/2010
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